Provider Demographics
NPI:1801406400
Name:GOODALE, MCKALEIGH B (PT)
Entity type:Individual
Prefix:
First Name:MCKALEIGH
Middle Name:B
Last Name:GOODALE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:15208 17TH AVE E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34212-8105
Mailing Address - Country:US
Mailing Address - Phone:941-780-5349
Mailing Address - Fax:941-360-1998
Practice Address - Street 1:2970 UNIVERSITY PKWY STE 105
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34243-2401
Practice Address - Country:US
Practice Address - Phone:941-360-1988
Practice Address - Fax:941-360-1998
Is Sole Proprietor?:No
Enumeration Date:2020-08-07
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT36086225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist